The impact of COVID-19 on incidence and outcomes from out-of-hospital cardiac arrest (OHCA) in Texas.

Introduction: Emerging research demonstrates lower rates of bystander cardiopulmonary resuscitation (BCPR), public AED (PAD), worse outcomes, and higher incidence of OHCA during the COVID-19 pandemic. We aim to characterize the incidence of OHCA during the early pandemic period and the subsequent long-term period while describing changes in OHCA outcomes and survival.

Methods: We analyzed adult OHCAs in Texas from the Cardiac Arrest Registry to Enhance Survival (CARES) during March 11-December 31 of 2019 and 2020.

STEMI Mimic: Focal Myocarditis in an Adolescent Patient After mRNA COVID-19 Vaccine.

Background: In May 2021, the U.S. Food and Drug Administration expanded the Emergency Use Authorization for the Pfizer-BioNTech mRNA Coronavirus disease 2019 (COVID-19) Vaccine (BNT162b2) to include adolescents 12-15 years of age.

Can I Send This Syncope Patient Home From the Emergency Department?

Background: Syncope is a common presentation to the emergency department (ED). A significant minority of these patients have potentially life-threatening pathology. Reliably identifying that patients require hospital admission for further workup and intervention is imperative.

Hide and Seek: Intermittent Preexcitation Wolff-Parkinson-White Syndrome Case Report and Management Overview.

Wolff-Parkinson-White (WPW) syndrome is an uncommon form of cardiac preexcitation due to an underlying structural accessory pathway, which may lead to potentially lethal arrhythmias. Classic electrocardiogram (ECG) findings of WPW include short PR interval, slurred upstroke of the QRS complex, and prolonged QRS duration. However, in intermittent preexcitation, a rare variant in contrast to continuous preexcitation, these findings are not always present, thus masking a diagnosis of WPW syndrome.

An Atypical Presentation of Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection is a rare form of acute coronary syndrome (ACS) resulting from tears in the coronary vessel lumen leading to myocardial ischemia. Historically, younger to middle-aged Caucasian females without traditional risk factors for ACS are most commonly affected. The authors present the case of an African American female with numerous traditional ACS risk factors who presented to the emergency department with chest pain.

ST-Segment Elevation in the Setting of Diabetic Ketoacidosis: Is It Acute Coronary Syndrome?

Diabetic ketoacidosis (DKA) with resulting hyperkalemia can lead to ST-segment elevations on electrocardiogram (ECG). Previous publications theorize that significant improvements in patient potassium levels lead to the resolution of this rare phenomenon, also known as "pseudo-infarct" pattern. The authors provide a unique case along with a literature review of DKA-associated ST-segment elevations.

An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction.

Introduction: Troponin is an integral component of the evaluation for acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI). However, troponin may be elevated in conditions other than OMI.

Objective: This narrative review provides emergency clinicians with a focused evaluation of troponin elevation in patients with myocardial injury due to conditions other than OMI.

Comminuted Femur Fracture in a Free Fall Jump: A Case Report.

Military free fall or high-altitude low-opening parachute jumps play a key role in special operations tactics, though injury patterns in these operators are not well characterized. In contrast to lower-altitude static line paratroopers, free fall operators require precise parachute deployment after a prolonged descent, with the potential for high-velocity trauma. This report describes a 33-year-old Marine Corps Reconnaissance operator who sustained left comminuted basicervical femoral neck fracture requiring cephalomedullary nail internal fixation with a full recovery.

A Comparison of Prehospital Versus Emergency Department Intubations in Iraq and Afghanistan.

Background: Airway obstruction is the second most common cause of potentially preventable death on the battlefield. We compared survival in the combat setting among patients undergoing prehospital versus emergency department (ED) intubation.

Methods: Patients were identified from the Department of Defense Trauma Registry (DODTR) from January 2007 to August 2016.

Emergency department septic shock patient mortality with refractory hypotension vs hyperlactatemia: A retrospective cohort study.

Background: Our objective was to compare in-hospital mortality among emergency department (ED) patients meeting trial-based criteria for septic shock based upon whether presenting with refractory hypotension (systolic blood pressure<90mmHg after 1L intravenous fluid bolus) versus hyperlactatemia (initial lactate≥4mmol/L).

Methods: We conducted a retrospective cohort analysis by chart review of ED patients admitted to an intensive care unit with suspected infection during 1 August 2012-28 February 2015. We included all patients with body fluid cultures sampled either during their ED stay without antibiotic administration or within 24h of antibiotic administration in the ED.

Sepsis Clinical Criteria in Emergency Department Patients Admitted to an Intensive Care Unit: An External Validation Study of Quick Sequential Organ Failure Assessment.

Background: Quick Sequential Organ Failure Assessment (qSOFA) is a prognostic score for patients with sepsis.

Objective: Our aim was to compare the area under the receiver operating curve (AUROC), sensitivity, specificity, and likelihood ratios of qSOFA vs. systemic inflammation response syndrome (SIRS) in predicting in-hospital mortality among emergency department (ED) patients with suspected infection admitted to intensive care units (ICUs).

Vancomycin-resistant enterococci colonization-infection model: parameter impacts and outbreak risks.

Vancomycin-resistant enterococci (VRE) infections have been linked to increased mortality and costs. A new model of a VRE-infested intensive care unit (ICU) is introduced. It incorporates critical features including the difference between colonization and infection, the role of special preventive care treatment cycles, fitness cost, and antibiotic use.